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Emergency Shower Manual
Operation & Maintenance
00102-R1-OM.16.01 Revised: January 14, 2016 Page 15 of 22
Sample
Weekly Inspection Report
Description
Complies
Station is well lit and designated by highly visible signage
Shower on same level as hazard and is free of obstruction
Shower is installed on a level surface accessible to Emergency Responders
All employees subject to exposure have been instructed in the location and use of
emergency equipment.
It is determined by using MSDS of known harmful substances the best course of action
in the event of an emergency.
Company Emergency Response Plan includes use of Emergency Shower
Spare coveralls are available in the event that employee clothes are contaminated
Eyewash outlets are protected from contamination
Door hardware opens smoothly and efficiently
Electrical options are in working condition;
o Interior light
o Space Heater works and maintains desired temperature
Upon activation of the Emergency Activation Switch
o Interior light comes ON
o Audible and Visible Alarms are operational
Flushing fluid tank is full
Using a temperature gauge, determine that the flushing fluid is tepid 16 - 38°C (60 -
100°F).
For Plumbed Units, also use the 'Emergency Shower Activation" List on a weekly basis.
When draining testing fluid be sure to drain away from walking locations, so as not to
create a hazard.
Performed By: Date:
Record all maintenance inspections and keep records.